Antihypertensives and the risk of serious hypoglycemia in older persons using insulin or sulfonylureas
R. I. Shorr, W. A. Ray, J. R. Daugherty and M. R. Griffin
Department of Preventive Medicine, University of Tennessee-Memphis College of Medicine and Methodist Hospitals of Memphis, 38104, USA.
CONTEXT: Beta-Blockers and angiotensin-converting enzyme (ACE) inhibitors
are effective antihypertensive agents for patients with diabetes mellitus.
However, beta-blockers attenuate some components of the autonomic response
to hypoglycemia and could increase the risk of hypoglycemia. ACE inhibitors
may increase insulin sensitivity and predispose users to hypoglycemia.
OBJECTIVE: To determine whether use of cardioselective beta-blockers,
nonselective beta-blockers, ACE inhibitors, thiazide diuretics, calcium
channel blockers, or other antihypertensive drugs alters the risk of
developing serious hypoglycemia among older persons prescribed insulin or
sulfonylureas. DESIGN: Retrospective cohort study. SETTING: Tennessee
Medicaid Program. PATIENTS: A total of 13,559 elderly (mean age, 78+/-7
years) Medicaid enrollees, who were prescribed insulin (n=5171, 38%) or
sulfonylureas (n=8368, 62%) from 1985 through 1989. These enrollees
contributed a total of 33,107 person-years of insulin or sulfonylurea use
for follow-up. MEASUREMENTS: Hospitalization, emergency department
admission, or death associated with hypoglycemic symptoms and a concomitant
blood glucose determination of less than 2.8 mmol/L (50 mg/dL). RESULTS: We
identified 598 persons with an episode of serious hypoglycemia during the
study period. The rate of serious hypoglycemia was 2.01 per 100
person-years among those who were not prescribed antihypertensives. Crude
rates of serious hypoglycemia were highest among users of ACE inhibitors
(2.47 per 100 person-years) and lowest among users of cardioselective
beta-blockers (1.23 per 100 person-years). However, when we controlled for
demographic characteristics and markers of comorbidity, there was no
statistically significant increase or decrease in risk of serious
hypoglycemia among users of any class of antihypertensive agents compared
with nonusers of antihypertensive drugs. Using nonselective beta-blockers
as the reference group, each of these agents was associated with a lower,
but not statistically significant, risk of hypoglycemia. CONCLUSIONS: In
this population, specific antihypertensive drug therapy had little impact
on the risk of hypoglycemia in older diabetic patients. Therapy should be
chosen based on other considerations of safety and effectiveness.
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ABSTRACT
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Winkelmayer et al.
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ABSTRACT
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DOC News 2006;3:5-5.
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Gilbert et al.
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ABSTRACT
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Doyle and Egan
Pharmacol. Rev. 2003;55:105-131.
ABSTRACT
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Kroner
Diabetes Spectr. 2002;15:249-255.
ABSTRACT
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Barzilay et al.
Diabetes Care 2001;24:654-658.
ABSTRACT
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Beta-blocker therapy for secondary prevention of myocardial infarction in elderly diabetic patients: Results from the national cooperative cardiovascular project
Chen et al.
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ABSTRACT
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